DOCSLIB.ORG

Frequently Asked Questions About Coding for Breast Surgery

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Frequently Asked Questions About Coding for Breast Surgery CODING AND PRACTICE MANAGEMENT CORNER Frequently asked questions about coding for breast surgery 52 | by Linda Barney, MD, FACS; Mark Savarise, MD, FACS; and Eric Whitacre, MD, FACS All of the image-guided oding for surgical services biopsy codes, 19081–19086, can be complicated due Why are there two separate specify that the biopsy is Cto the numerous rules, codes to report for breast inclusive of the placement guidelines, and exceptions— cancer operations with of breast localization all of which the Centers sentinel node biopsy and one unified code for mastectomy devices, including clips for Medicare & Medicaid Services frequently updates or lumpectomy with and metallic pellet when and revises. Consequently, the axillary node dissection? performed, and imaging American College of Surgeons The breast surgery Current of the biopsy specimen, (ACS) General Surgery Procedural Terminology (CPT) when performed. Coding and Reimbursement codes were developed when Committee (GSCRC) often axillary dissection was standard receives questions about therapy for breast cancer. coding, particularly for Modified radical mastectomy breast surgery. This column is coded 19307; lumpectomy responds to some frequently with axillary dissection is coded asked coding questions 19302. When sentinel lymph related to breast cancer node biopsy was developed, the operations, sentinel node code needed to be applied to both biopsy, ultrasound-guided core breast and melanoma procedures. biopsies, excision with wires, Code 38900 is an add-on code to intraoperative assessment be used with any lymph node of margins, and more. biopsy or lymphadenectomy code V99 No 9 BULLETIN American College of Surgeons CODING AND PRACTICE MANAGEMENT CORNER to indicate the intraoperative placement of breast localization describes the procedure where work done to identify the devices, including clips and margin status is indicated by any sentinel lymph nodes. Therefore, metallic pellet when performed, method and may include excision lumpectomy with sentinel and imaging of the biopsy of additional surrounding tissue node biopsy is billed using specimen, when performed. In for margins. As a corollary, codes 19301, 38525-51, and other words, you cannot report use code 19301 whether the 38900. Total mastectomy with separately for clip placement breast cancer is palpable or is sentinel node biopsy uses codes or specimen imaging, but that removed with preoperative 19303, 38525-51, and 38900. the code is appropriate for the placement of a localization wire. biopsy regardless of whether clip placement or specimen When a total mastectomy imaging are included. How do you code re-excision with sentinel node biopsy is of a lumpectomy cavity when performed, I obtain a frozen you must return for positive section of the nodes and Do you code differently margins on final pathology a proceed to dissect the axilla for excision with multiple week after a lumpectomy? if positive. Can I use multiple wires for localization Use code 19301-58 for codes for this procedure? than with one wire? lumpectomy with modifier | 53 This is a modified radical The new image-guided for “staged/related procedure mastectomy (19307) with sentinel localization codes are per in the postoperative period.” node mapping procedure lesion, not per wire. Multiple Indicate in the operative report (38900). The axillary node biopsy wires may be placed to identify that this procedure is a planned cannot be reported separately any lesion. An excision may return to the operating room from the axillary dissection. only be reported once through for a more extensive work. a single incision, regardless of the number of wires Can I code for injection of used for the localization. Could I code for the X ray radioactive tracer and blue dye of the operative specimen for sentinel lymph node biopsy? with CPT code 76098? If you preoperatively inject How do you code for For all image-guided breast radioactive tracer, report 38792. excision of additional tissue excisions, the radiographic Injection of blue dye, when for margins at the time of evaluation of the specimen is performed, is included in the lumpectomy? Is there a bundled into the localization sentinel node code, 38900. code for the added work of procedure, and should not orienting and inking margins? be coded separately. CPT codes 19120 and 19125 I perform ultrasound-guided are used for excision of breast core biopsies but do not leave lesions, where attention to How would I code for localization devices in the surgical margins and assurance intraoperative assessment of biopsy location. Should I use of complete tumor resection margins, for instance, with codes 19083 and 19084? is unnecessary. Oncologic radiofrequency spectroscopy? Yes. All of the image-guided resection with attention to There is no specific CPT code biopsy codes, 19081–19086, specify margins (lumpectomy or partial for reporting intraoperative that the biopsy is inclusive of the mastectomy), code 19301, assessment of margins by SEPT 2014 BULLETIN American College of Surgeons CODING AND PRACTICE MANAGEMENT CORNER For all image-guided breast excisions, the radiographic evaluation of the specimen is bundled into the localization procedure, and should not be coded separately. any particular method, such fibroadenomas is 19105. The as preparing touch-prep or How do you code for FDA has also approved laser frozen specimens, which are intraoperative radiation or ablation of fibroadenomas, considered integral to the work placement of the different but a CPT code has yet to be 54 | of a lumpectomy for malignancy devices for brachytherapy? established. RFA and high- (CPT code 19301). Intraoperative At present, no code has been frequency microwave ablation guidance with ultrasound designated for intraoperative are considered investigational. imaging for assessment of radiation treatment of the If you have questions or margins can be reported (CPT breast. Codes for placement comments regarding this code 76998) only if permanent of brachytherapy catheters column, contact Sarah Kurusz, images are obtained and saved, are available and can be ACS Practice Affairs Associate, and an ultrasound report is used regardless of the brand at [email protected] or 202- entered into the medical record. (Mammosite, SAVI, Contura, 672-1505. If you have additional and so on). These codes are coding questions, contact the 19296 for delayed insertion and ACS Coding Hotline at 800-227- How should I code for nipple- 19297 for immediate insertion 7911 between 8:00 am and 5:00 sparing mastectomy and at the time of lumpectomy. pm, CST, excluding holidays. skin-sparing mastectomy to distinguish them from total mastectomy? How do you code for Editor’s note All of these procedures are ablation of breast Accurate coding is the classified mastectomy for lesions with cryotherapy, responsibility of the provider. cancer and should all be microwave, RFA, or laser? This summary is only a resource coded with 19303. No special The Food and Drug to assist in the billing process. distinctions are made for the Administration (FDA) has not type of incision. The operative approved ablation of breast report should use the wording lesions with cryotherapy, “total nipple-sparing” or “total microwave, or radiofrequency skin-sparing” mastectomy ablation (RFA), or laser for to avoid confusion with a treatment of breast cancer. The subcutaneous mastectomy. CPT code for cryotherapy of V99 No 9 BULLETIN American College of Surgeons.
Load more

Recommended publications
  • Surgical Options for Breast Cancer
    The Breast Center Smilow Cancer Hospital 20 York Street, North Pavilion New Haven, CT 06510 Phone: (203) 200-2328 Fax: (203) 200-2075 SURGICAL OPTIONS There are a number of surgical procedures available today for the treatment of breast cancer. You will likely have a choice and will need to make your own decision, in consultation with your specific surgeon, about the best option for you. We offer you a choice because the research on the treatment of breast cancer has clearly shown that the cure and survival rates are the same regardless of what you choose. The choices can be divided into breast conserving options (i.e. lumpectomy or partial mastectomy) or breast removing options (mastectomy). A procedure to evaluate your armpit (axillary) lymph nodes will likely occur at the same time as your breast surgery. This is done to help determine the likelihood that cells from your breast cancer have left the breast and spread (metastasized) to another more dangerous location. This information will be used to help decide about your need for chemotherapy or hormone blocking drugs after surgery. PARTIAL MASTECTOMY (LUMPECTOMY) A partial mastectomy involves removing the cancer from your breast with a rim, or margin, of normal breast tissue. This allows the healthy noncancerous part of your breast to be preserved, and usually will not alter the sensation of the nipple. The benefit of this surgical choice is that it often preserves the cosmetics of the breast. Your surgeon will make a decision about the volume of tissue that needs removal in order to maximize the chance of clear margins as confirmed by our pathologist.
    [Show full text]
  • Lumpectomy/Mastectomy Patient/Family Education
    LUMPECTOMY/MASTECTOMY PATIENT/FAMILY EDUCATION Being diagnosed with breast cancer can be emotionally challenging. It is important to learn as much as possible about your cancer and the available treatments. More than one type of treatment is commonly recommended for breast cancer. Each woman’s situation is unique and which treatment or treatments that will be recommended is based on tumor characteristics, stage of disease and patient preference. Surgery to remove the cancer is an effective way to control breast cancer. The purpose of this educational material is to: increase the patient’s and loved ones’ knowledge about lumpectomy and mastectomy to treat breast cancer; reduce anxiety about the surgery; prevent post-operative complications; and to facilitate physical and emotional adjustment after breast surgery. THE BASICS There are three primary goals of breast cancer surgery: 1. To remove a cancerous tumor or other abnormal area from the breast and enough surrounding breast tissue to leave a “margin of safety” around the tumor or affected area. 2. To remove lymph nodes from the armpit area (axilla) to check for possible spread of cancer (metastasis) or remove lymph nodes that are already known to contain cancer. 3. Sometimes one or both breasts are removed to prevent breast cancer if a woman is at especially high risk for the disease. Breast cancer surgery can be done before or after chemotherapy (if chemotherapy is recommended). Radiation therapy and hormonal therapy (if recommended) are typically done after surgery. There are several types of breast surgery. The type of surgery best suited for a specific woman depends on the type of breast disease, the size and location of the breast disease/tumor(s) in the breast, and the personal preference of the patient.
    [Show full text]
  • Advances in Breast Reconstruction After Lumpectomy and Mastectomy
    ADVANCES IN BREAST RECONSTRUCTION AFTER LUMPECTOMY AND MASTECTOMY Breast cancer has been described as far back as 1600 B.C. in the papyrus writings of the ancient Egyptians. Galen later theorized that the cancer was due to a collection “of black bile” inside the breast. Virchow proposed this so-called “tumor” originated from the epithelium and spread outward in all directions. The American surgeon William Halsted supported the theory that breast cancer began as a “regional” phenomenon, before it spread distantly. And in 1882 he first performed the first Radical Mastectomy, which involved removal of the entire breast, the lymph nodes in the area, and the underlying pectoralis chest wall muscles. As you can imagine, this led to a very disfiguring appearance, but Halsted was able to achieve a 5-year cure rate of 40% which was unheard of at the time. Because of Halsted’s principles, breast reconstruction was really never an option since it was considered a “violation of the local control of the disease.” Halsted warned surgeons not to perform plastic operations at the mastectomy site because he believed it could hide local recurrence and “may sacrifice his patient to disease.” Therefore, many of the initial attempts at breast reconstruction took place in Europe. EARLY BREAST RECONSTRUCTION Breast reconstruction itself dates back to the 1800s, with the initial attempt taking place in 1895 by the German surgeon, Vincent Czerny. He reported the case of a 41 year old singer who required a mastectomy for a fibroadenoma and chronic infections. He reported that “since both breasts were very well developed” she would have “an unpleasant asymmetry” after removal of one breast, which would have “hindered her stage activity”.
    [Show full text]
  • Consensus Guideline on the Management of the Axilla in Patients with Invasive/In-Situ Breast Cancer
    - Official Statement - Consensus Guideline on the Management of the Axilla in Patients With Invasive/In-Situ Breast Cancer Purpose To outline the management of the axilla for patients with invasive and in-situ breast cancer. Associated ASBrS Guidelines or Quality Measures 1. Performance and Practice Guidelines for Sentinel Lymph Node Biopsy in Breast Cancer Patients – Revised November 25, 2014 2. Performance and Practice Guidelines for Axillary Lymph Node Dissection in Breast Cancer Patients – Approved November 25, 2014 3. Quality Measure: Sentinel Lymph Node Biopsy for Invasive Breast Cancer – Approved November 4, 2010 4. Prior Position Statement: Management of the Axilla in Patients With Invasive Breast Cancer – Approved August 31, 2011 Methods A literature review inclusive of recent randomized controlled trials evaluating the use of sentinel lymph node surgery and axillary lymph node dissection for invasive and in-situ breast cancer as well as the pathologic review of sentinel lymph nodes and indications for axillary radiation was performed. This is not a complete systematic review but rather, a comprehensive review of recent relevant literature. A focused review of non-randomized controlled trials was then performed to develop consensus guidance on management of the axilla in scenarios where randomized controlled trials data is lacking. The ASBrS Research Committee developed a consensus document, which was reviewed and approved by the ASBrS Board of Directors. Summary of Data Reviewed Recommendations Based on Randomized Controlled
    [Show full text]
  • Mastectomy for Invasive Breast Cancer 1 4
    Mastectomy for Invasive Breast Cancer 1 4 Tracy-Ann Moo and Rache M. Simmons Abbreviations transection of the long thoracic and thoracodor- sal nerves, which was routinely performed at DCIS Ductal carcinoma in situ the time. NAC Nipple-areola complex By the mid-1900s, the modifi ed radical mastectomy, which spared the pectoral muscles, began to gain widespread support as a less Introduction morbid procedure that could achieve results equivalent to the radical mastectomy [ 3 – 6 ]. The The mastectomy procedure has evolved consider- modifi ed radical mastectomy would in subse- ably since the era of the radical mastectomy. In quent decades be replaced by the total or simple the late 1800s, Halsted and Mayer described the mastectomy, which eliminated the axillary radical mastectomy in individual reports on the lymph node dissection. However, around the treatment of breast cancer. The radical mastec- same time, other groups advocated for a more tomy involved removal of the breast and pectoral extensive resection as a means of achieving muscles in conjunction with an axillary and greater local control, the extended radical mas- infraclavicular lymph node dissection [1 , 2 ]. At a tectomy [ 7 , 8 ]. The extended radical mastec- time when no effective adjuvant treatment tomy was a more morbid procedure removing existed, this en bloc resection provided the best not only the infraclavicular and axillary lymph rates of local control. The obvious drawbacks to nodes but also the supraclavicular and paraster- such a radical procedure included chronic lymph- nal lymph nodes. edema, as well as neurologic defi cits related to To address this growing dichotomy in surgical treatment options, the fi rst randomized trials in breast cancer treatment were conceived.
    [Show full text]
  • Breast Cancer Surgery and Oncoplastic Techniques Aaron D
    Breast CanCer surgery and OnCOplastiC teChniques Aaron D. Bleznak, MD, MBA, FACS Medical Director Breast Program, Ann B. Barshinger Cancer Institute Penn Medicine Lancaster General Health INTRODUCTION For more than a century after the standardiza- compared total mastectomy to lumpectomy (breast tion of the radical mastectomy procedure by William conserving surgery or BCS) with or without radiation Stewart Halsted at Johns Hopkins in the late 19th therapy, demonstrated that the extent of surgery does century, the mainstay of breast cancer treatment not impact cure rates1,2 (Fig. 1). Other randomized has been surgical resection. Removal of the primary trials in the United States and internationally, with breast cancer is curative for those women whose as much as 35 years of follow-up, have confirmed that malignancy has not metastasized to distant sites, and the extent of resection does not affect disease-specific in the current era of mammographic screening, that and overall survival rates.3 is the fortunate status of most women when their Over the ensuing decade after the landmark breast cancer is first diagnosed. NSABP B-06 study, these lessons were incorporated Our understanding of the route of breast can- into oncologic practice, and we achieved a relatively cer metastasis has evolved since Halsted’s time. His steady state in rates of breast conservation (Fig. 2, theory of initial spread via lymphatic channels, which next page). From 2007 to 2016, breast-conserving eventually empty into the vascular system, has evolved surgery was used in approximately 60% of women into our current appreciation that primary spread is with breast cancer cared for in hospitals accredited hematogenous.
    [Show full text]
  • Radical Mastectomy to Radical Conservation (Extreme Oncoplasty): a Revolutionary Change
    IS RAVDIN LECTURE IN THE BASIC AND SURGICAL SCIENCES Radical Mastectomy to Radical Conservation (Extreme Oncoplasty): A Revolutionary Change Melvin J Silverstein, MD, FACS After 4 decades of caring for patients with breast cancer, I seen a case in which it was used, and probably have never have come to the conclusion that the combination of mas- even heard the term. tectomy, reconstruction, and radiation therapy is the least This article will take you on a 50-year journey, from desirable option for local treatment. Although it may be 1965 to the present: from radical mastectomy to extreme an unavoidable approach for some patients, for many oncoplasty, from mutilation to the opposite, to less local there may be better options that yield equal survival rates recurrence, to a lower breast cancer mortality rate, to with a superior quality of life. Let me explain. a better quality of life, to better cosmesis, and to breast Everyone knows the definition of radical mastectomy, a conservation even when mastectomy is thought to be procedure conceived and popularized by William S indicated. Halsted, MD. It removes the entire breast, the underlying pectoral muscles, and the axillary lymph nodes, leaving behind a depression under the clavicle, prominent ribs, LEARNING THE BASICS and a markedly deformed patient. Most younger surgeons I was a surgical resident from 1965 to 1970 at what was have never performed or even observed the procedure and then the Boston City Hospital, a group of more than never will. It has virtually no role in modern breast cancer 20 aging medical buildings connected by tunnels so that surgery.
    [Show full text]
  • Icd-9-Cm (2010)
    ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular
    [Show full text]
  • Radical Mastectomy and Reconstruction by Brittany Stapp-Caudell
    B I L A T E R A L T O T A L M O D I F I E D Radical Mastectomy and Reconstruction by Brittany Stapp-Caudell As thousands of women every year are being diagnosed with breast cancer, bilateral mastectomies are becoming both the prophylactic as well as the therapeutic procedure of choice for women young and old to prevent as well as to combat the aggressive, potentially deadly breast cancers. This arti­ cle will investigate the indications for mastectomy surgery, as well as a case study of a bilateral modified radical mastectomy in the clinical setting. I N T R O D U C T I O N n today’s society, the term “mastectomy” is commonplace L E A R N I N G O B J E C T I V E S in medical terminology, as well as in the postings of an I operating room’s surgery schedule and insurance billing ▲ Examine the evolution of the requests. As thousands of women every year are being diag- mastectomy procedure nosed with breast cancer, bilateral mastectomies are becoming both the prophylactic, as well as therapeutic procedure of choice ▲ Explore the affected anatomy for women, young and old, to prevent and combat aggressive, potentially deadly, breast cancers. ▲ Compare and contrast different surgical options for breast cancer B R E A S T A N A T O M Y The female breasts are paired anatomical structures on the ante- ▲ Evaluate the breast cancer rior portion of the thoracic region of a human being. Both males staging process and females have breasts, although the normal anatomy and physiology of the structures varies vastly between the two sexes.
    [Show full text]
  • Mariotti 2014 Chapter Conservative Surgery and on Coplas
    Conservative Surgery 4 and Oncoplastic Surgery Carlo Mariotti, Pietro Coletta, Sonia Maurizi, and Elisa Sebastiani 4.1 The Evolution of Breast Surgery Breast cancer (BC) is a nosological entity of high social interest due to its high rate of occurrence, as well as to the devastating consequences that patients may suffer, both esthetically and psychologically, and also in terms of the economic and organizational commitment to research and public health that it entails. It is needless to say that the importance of the breast for women goes beyond its mere biological function, since it is among the most significant symbols of femininity and sexuality. The total or partial removal of the breast alters the patient’s body image, with serious consequences for her daily/working life and relationships, often triggering psychological disorders, that vary in type and severity. Therefore, the surgical approach, besides pursuing oncologic radicality, needs to encom- pass an adequate cosmetic solution for the patient. These considerations, which nowadays seem to be obvious, are the outcome of a great conceptual evolution that has marked an epochal change in BC surgery, a revolution, which has lasted for more than a century and based on various elements: • Scientific research, which, over the years, has gained a more and more refined knowledge of the biological factors that influence biological behaviour and natural history of the disease • Improvement of diagnostic tools • Increased treatment options • Growth of cultural awareness of the problem for women • Role of the mass media. C. Mariotti () Department of Surgery, Breast Surgery Unit, Ospedali Riuniti University Hospital, Ancona, Italy e-mail: [email protected] C.
    [Show full text]
  • Complications in Breast Surgery Angelique F
    Surg Clin N Am 87 (2007) 431–451 Complications in Breast Surgery Angelique F. Vitug, MD, Lisa A. Newman, MD, MPH, FACS* University of Michigan, Breast Care Center, 1500 East Medical Center Drive, 3308 CGC, Ann Arbor, MI 48167, USA The breast is a relatively clean organ comprised of skin, fatty tissue, and mammary glandular elements that have no direct connection to any major body cavity or visceral structures. In the absence of concurrent major recon- struction, breast surgery generally is not accompanied by large-scale fluid shifts, infectious complications, or hemorrhage. Thus, most breast opera- tions are categorized as low-morbidity procedures. Because the breast is the site of the most common cancer afflicting American women, however, a variety of complications can occur in association with diagnostic and mul- tidisciplinary management procedures. Some of these complications are related to the breast itself, and others are associated with axillary staging procedures. This article first addresses some general, nonspecific complica- tions (wound infections, seroma formation, hematoma). It then discusses complications that are specific to particular breast-related procedures: lump- ectomy (including both diagnostic open biopsy and breast-conservation therapy for cancer), mastectomy; axillary lymph node dissection (ALND), lymphatic mapping/sentinel lymph node biopsy, and reconstruction. Com- plications related to reconstruction are discussed in a separate article in this issue. General wound complications related to breast and axillary surgery Because it is a peripheral soft tissue organ, many wound complications related to breast procedures are relatively minor and frequently are man- aged on an outpatient basis. It therefore is difficult to establish accurate in- cidence rates for these events.
    [Show full text]
  • Getting Prepared for Your Pre and Post-Operative Breast Surgical Path
    Getting Prepared for Your Pre and Post-operative Breast Surgical Path: Welcome Thank you for choosing Kaleida Health for your breast surgery. We are dedicated to helping you through this very challenging time of your life. Our team is proud to serve you and we are focused on helping you achieve the best possible outcome with quality medical treatment, attentive bedside care, and the latest rehabilitation therapies. Each patient progresses differently, so your program will be designed to meet your specific needs. We want you to achieve a full recovery so you can get back to your life as quickly as possible, but this can only be accomplished if everyone works together. The skill and dedication of your physicians, nurse practitioners, nurses and therapists are only half of the team. You (the patient) and your family represent the other half of the team and will play a big role in your successful recovery. We are honored to be your preferred service provider. 2 Pre-Admission General Information What to Bring to the Hospital Pack a small pillow for the trip home to help with any bumps along the way (the pillow will also help with the pressure of the seat belt). Personal care items such as chapstick, hairbrush, glasses, denture supplies and hearing aids picture ID, insurance card and your healthcare proxy and advanced directives if in place Clothing/Undergarments The day of surgery, dress comfortably with loose fitting clothes that open in the front to make getting dressed for the trip home easier. Front closing pajama tops can also be helpful during your recovery.
    [Show full text]